When CRP values were less selleck than or equal to 40 mg L, malnutrition significantly increased the chance of low plasma selenium. With values higher than 40 mg L, the magnitude of the inflammatory response prevailed over malnutrition, which ceased to be significantly associated with the outcome. Similarly, there was a significant affect of CRP concentrations on low plasma selenium in well nourished patients but not in the malnourished. Malnutrition must be considered when understanding low plasma selenium concentrations, especially in patients in which the inflammatory response is not as severe. In this context, malnutrition somewhat reduced the importance of CRP concentrations on low plasma selenium risk.

Therefore, one must consider both factors the magnitude of the inflammatory response as well as nutritional status when interpreting plasma selenium concentrations in patients under metabolic Inhibitors,Modulators,Libraries stress. Study limitations The main limitation of this study was defining the low plasma selenium outcome variable based on the median study sample selenium value. In our study, the definition of the median as a cutoff was adopted because, similar to other adult and child studies, plasma Inhibitors,Modulators,Libraries selenium concentrations were below the lower limit in most patients. This factor coupled with the high prevalence of malnutrition Inhibitors,Modulators,Libraries in our ICU plus the evidence of selenium deficiency in some areas of Brazil, should be considered when generalizing these results to other units with different profile. In addition, the relation between malnutrition and selenium deficiency should be nuanced.

Although multiple micronutrient deficiencies are inherent in malnutrition, selenium deficiency may occur without Inhibitors,Modulators,Libraries visible protein energy malnutrition depending on the selenium content of the food. Hence, the link between malnutrition and nutritional selenium deficiency depends on the selenium content of the soil and food and on the type of malnutrition. It is well established that selenium is an essential micronutrient for antioxidant defenses that has reduced plasma concentrations during a systemic inflammatory response. However, the benefit of selenium supplementation in all critically ill patients is still not proven. Meta analyses have shown that high dose selenium might have beneficial effects in patients with sepsis syndrome, but there are significant heterogeneity of protocols, patients and outcomes in the different trials.

The results of our study show that low plasma concentrations are not necessarily indicative of systemic Inhibitors,Modulators,Libraries inflammation only, but may also reflect nutritional deficiency. Low plasma selenium concentrations in malnourished patients may be an indication for supplementation, whereas this does PF-2341066 not necessarily mean that all patients with low plasma selenium should be supplemented.